Transacting self-preservation: a grounded theory of the spiritual dimensions of people with terminal cancer

doi:10.1016/S0020-7489(99)00012-7

International Journal of Nursing Studies

Volume 36, Issue 3, June 1999, Pages 191-201

https://doi.org/10.1016/S0020-7489(99)00012-7 Get rights and content

Abstract

This study describes the spiritual meanings people with terminal cancer give to their everyday life-experiences. Transcriptions from semi-structured, in-depth interviews of 19 adults who had a diagnosis of cancer and who were living in Queensland and New South Wales, Australia, were analysed using the constant comparative approach of grounded theory. The study found that people with terminal cancer develop a spiritual perspective that strengthens their approaches to life and death. Their discovery of spiritual meaning is enacted through a process of transacting self-preservation. This process incorporates three phases, taking it all in, getting on with things and putting it all together. As people with terminal cancer move through these phases they transact self-preservation by discovering deeper levels of understanding self. This discovery of self incorporates a higher level of spiritual growth, spiritual perspective, spiritual awareness and spiritual experiences. The study indicates that nurses can help people with terminal cancer develop coping strategies that allow them to engage in the process of transacting self-preservation. This study also shows that there needs to be more emphasis on spirituality, spiritual issues and the role of spiritual caring in nursing curricula and practice.

Introduction

For some writers, spirituality equates with faith, hope, trust, the giving and receiving of love, forgiveness, reconciliation, and meaning in life McGlone, 1990, Taylor and Ferszt, 1990, Widerquist, 1992. Spirituality is also sometimes considered a basic determinant of the totality of a person or a central life force that contributes to a person's wholeness Amenta and Bohnet, 1986, Hiatt, 1986. Peck (1993) has said that a person's spirituality involves a journey of personal growth that culminates in a deep sense of interconnectedness between the person and other people and a sense of connection with a higher metaphysical, but not necessarily a religious, being. Other writers have considered spirituality in terms of interpersonal, transpersonal, and/or intrapersonal experiences and processes Hover-Kramer, 1989, Johnson, 1991. For the purposes of this paper, spirituality is viewed as an inherent aspect of the individual self incorporating a source of strength developed through a person's faith in self, others, God and/or another Higher Being. Spirituality reflects an expanded consciousness beyond a biopsychosocial awareness and gives meaning and purpose to a person's life as they transcend their everyday experiences (Thomas, 1997).

Although nurses have begun to consider a person's spirituality as meaningful and as an important aspect of holistic care, they often fail to fully meet this aspect of their patients' needs Lane, 1987, Trice, 1990, Di Meo, 1991, Corrine et al., 1992. One group for whom spirituality is an important aspect needing deeper understanding is people with terminal cancer (O'Connor et al., 1990). However, there is virtually no research that describes the relationship between a person with terminal cancer and their spirituality.

`Transacting self-preservation' is a process that reflects people's ways of finding spiritual meaning in their experiences of terminal cancer and how they achieve deeper levels of spirituality during the three phases of this process. These phases incorporate `taking it all in', `getting on with things' and `putting it all together', that describe coping strategies people with terminal cancer use to overcome the barriers that hinder the discovery of a meaningful existence when facing death. Transacting self-preservation implies deeper levels of understanding self through spiritual growth, spiritual perspective, spiritual awareness and spiritual experiences.

Section snippets

Study purpose

The purpose of this study was to construct a grounded theory that explains how the spirituality of people with terminal cancer develops as they make sense of and come to terms with their diagnosis. The study was underpinned by a desire to establish answers to questions such as: What are the spiritual experiences of people with terminal cancer? How do people with terminal cancer create meaning and purpose in their living and dying processes? and How can this meaning be understood from a

The sample

The sample (n=19; female=12; males=7) consisted of voluntary participants who had a diagnosis of terminal cancer, were between 30 and 90 years of age and had sufficient English proficiency to allow communication with the researcher. The purposive sample meant that participants were selected on the basis they could provide insight into the phenomena being studied and was developed mainly through `snowballing', that is, by one person introducing another to the study. At initial contact,

Data collection and analysis

For this study, grounded theory was used because it could help the researcher understand and give meaning to the spiritual aspects of people with terminal cancer by `taking the role of the other' (Wilson, 1989, p. 455). From this position the researcher could interpret the experiences of people with terminal cancer as they emerged from their own detailed accounts Parse et al., 1985, Burns and Grove, 1987. Once agreement to participate was obtained, interviews were arranged with participants,

Deriving the elements of the grounded theory

The data analysis process led to the identification of a single unifying core category labelled `transacting self-preservation'. The grounded theory asserts that people with terminal cancer develop their spiritualness as they make sense of and come to terms with their diagnosis, and this can be understood in the context of transacting self-preservation. Evolution of this process is dependent on three dynamic and interconnected behaviours, that is, `taking it all in', `getting on with things'

Transacting self-preservation: taking it all in

Taking it all in (see Fig. 1) began once the diagnosis had been made known to the participant and involved them `responding' and `questioning' their perceptions of the cancer illness and how they perceived their outcome. Responding reflected shock, fear, unpreparedness, denial and unacceptance of the illness and impending death. Participants commonly responded to the diagnosis of cancer with “I couldn't come to terms with it”, “I just couldn't believe it” and “[cancer] sort of sprung up ... now

Transacting self-preservation: getting on with things

In getting on with things, the initial shock and adjustments of `taking it all in' had abated (but not necessarily entirely resolved) and participants were more able to confront the reality of their diagnosis. In `getting on with things', participants thought about cancer often, to the point that it permeated all aspects of their existence and governed and structured their lives. They often recounted events according to time dimensions of their experience of cancer, for example, “before I had

Transacting self-preservation: putting it all together

As shown in Fig. 1, putting it all together involved participants `creating meaning' in their terminal cancer experience and `discovering self'. Creating meaning refers to the time when participants reached a turning point and took full stock of their life for the first time. Meaning and purpose in their experiences were enriched and enhanced through gaining insight, changing their outlook on life, dealing with unfinished business where possible and getting on with living more fully.

When

Transacting self-preservation: intervening conditions

While the process of transacting self-preservation following a diagnosis of terminal cancer was an intensely personal one, common threads in the experience can be seen, that is, taking it all in, getting on with things and putting it all together. Each of these commonalities were mediated at the individual level by a number of intervening conditions (see Fig. 1). These were attitudes, support, age, gender, experience/knowledge and faith.

Participants' attitudes varied from `hopelessness' to

Discussion

When a person confronts a crisis, its impact often leads that person to seek reasons for the crisis and to give meaning to its intrusion in their life. This study has shown that the search for meaning in the terminal cancer experience arises from the person's need for self-preservation. Transacting self-preservation is made complete as the person reaches a deeper level of understanding of self that is imbued with spiritual growth embodied in a deeper sense of spiritual perspective, an enhanced

Conclusion

There is no denying the importance of a spiritual dimension that gives meaning to the everyday experiences of people with terminal cancer. These people encounter an urgency to explore their sense of meaning in life, in the face of their impending death. As a major avenue of support for those with terminal cancer, nurses need to provide them with hope and positive expectations that reflect their own spiritual awareness. If these expectations are to be met, it is important that nurses deal with

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Transacting self-preservation: a grounded theory of the spiritual dimensions of people with terminal cancer

Abstract

Introduction

Section snippets

Study purpose

The sample

Data collection and analysis

Deriving the elements of the grounded theory

Transacting self-preservation: taking it all in

Transacting self-preservation: getting on with things

Transacting self-preservation: putting it all together

Transacting self-preservation: intervening conditions

Discussion

Conclusion

Journal of Professional Nursing

Nursing Care of the Terminally Ill

The Practice of Nursing Research: Conduct, Critique and Utilization

The unheard voices of women: Spiritual interventions in maternal–child health

American Journal of Maternal Child Nursing

Patient's advocate, Rx for spiritual distress. A guide to religious practices

RN

Managing spiritual distress in patients with advanced cancer pain

Cancer Nursing

Spirituality, medicine, and healing

Southern Medical Journal

Creating a context for self-healing: The transpersonal perspective

Holistic Nursing Practice

Conquering Cancer: an Invitation to Hope

On Death and Dying

Healing the spirit

Holistic Nursing Practice

Raising the spirits ... spiritual assessment

Nursing Times

In-Depth Interviewing: Researching People